The effect of malaria on the body. Malaria symptoms, treatment and prevention rules
Malaria is a common cause of death from travel-acquired infection in the UK. Malaria cannot be ruled out in all febrile patients returning from malaria-endemic areas.
Pathogenesis:
- in all forms, the pathogen enters the body at the sporozoite stage;
- sporozoites are introduced into hepatocytes - tissue schizogony develops here, merozoites are formed;
- when hepatocytes disintegrate, merozoites develop in erythrocytes - the pathogen multiplies in erythrocytes, which leads to rupture of erythrocytes - the cycle lasts 48 hours, and in a tropical cycle - 72 hours;
- the onset of an attack indicates a rupture of red blood cells;
- during schizogony, gamonts (male and female) are formed;
- gamonts.
Epidemiology of malaria
Mechanism of transmission: transmissible, may be parenteral transmission - through blood transfusion or through instruments, objects contaminated with blood. There may be infection during childbirth.
Causes of malaria
The causative agent of malaria
Plasmodium falciparum is the causative agent of the most severe and potentially fatal or malignant form of malaria.
P. vivax, P. ovale and P. malariae can cause chronic, relapsing disease but are not life-threatening.
There are no reliable clinical criteria to distinguish each type of infection. The morphology of different types of pathogens when examined in a blood smear is different, but this requires expert interpretation. A reliable malaria antigen detection test can be used to differentiate between P. falciparum and P. vivax. Infection with several types of pathogens is possible. If there is doubt about the pathogen species, therapy should be directed against P. falciparum.
Malaria mosquitoes
It is generally accepted that malaria mosquitoes mostly live in hot, humid countries, and in Russia there are no suitable conditions for them. However, this opinion is wrong. In fact, only the Far North and parts of Eastern Siberia have winter temperatures low enough to prevent the mosquito family from surviving.
The malaria mosquito has its own name - Anopheles. This is just one genus of mosquitoes from their large family, but in Russia there are 9 species of them. No other mosquitoes are capable of transmitting Plasmodium falciparum to humans. By appearance, it is almost impossible to distinguish Anopheles from other fellows. Its biological features (long hind legs, black spots on the wings, special position of the body during a bite, etc.) are known only to biologists, and even then, those specializing in the study of dipterans.
An ordinary person does not particularly examine the mosquito in detail, but tries to swat it as quickly as possible.
Fortunately, in order for a person to be infected by a malaria mosquito, the most important condition is necessary: the presence of a person suffering from malaria, and in Russia it has been practically eliminated and only variants of imported infection are possible. However, in our time of widespread migration of different segments of the population, such a possibility cannot be excluded. In addition, an infectious mosquito can be accidentally introduced into an uninfected area. Therefore, local outbreaks of malaria are quite possible and occur periodically. Cases of this disease, for example, are constantly recorded in the Astrakhan region.
If Anopheles does not drink blood infected with malarial plasmodium, it will not be able to become a carrier of malaria, but will remain an ordinary mosquito for everyone. Its bite is as safe as the bites of its fellow tribesmen.
Why does malaria cause fever?
Feverish chills during malaria are caused by pathology in the heat exchange system. Plasmodium toxins, and most importantly, their “fragments” are foreign proteins, therefore they change the specific reactivity of the body and destabilize the work of the heat regulation center in the body.
The minimum amount of pathogen that can cause symptoms of malaria is called the pyrogenic threshold. This threshold depends on the level of human immunity and the individual characteristics of the body.
As a result of the temperature reaction, blood circulation deteriorates, and this condition leads to disruption of tissue nutrition, changes in metabolism, as well as stagnation of some blood and the development of an inflammatory process in these areas.
The destruction of red blood cells by the malaria pathogen leads to hemolytic anemia. It is this process that causes lethargy, weakness, shortness of breath, dizziness, and a tendency to faint.
A foreign protein leads to increased tissue sensitivity (sensitization of the body) and the development of autoimmune pathology.
Touches to the portrait of malaria
Only at the end of the last century, scientists discovered that dormant forms of some types of malarial plasmodium can exist (persist) in the liver for a long time. They have the ability to wake up, enter the bloodstream and cause a relapse of malaria after many months and even years. Every year, millions of people around the world die from malaria, several times more than from AIDS. Over the past decade, malaria, which traditionally ranked third in mortality among infectious diseases, has become a leader in this indicator.
Due to the increased greenhouse effect and climate warming, areas favorable for the breeding of malaria mosquitoes are gradually moving north. A person who has had malaria cannot be a donor for 3 years after the illness. In the future, when donating blood, it is necessary to warn doctors that the person has suffered from malaria. Malaria mosquitoes are attached to standing water. They are not able to fly more than 8 km, so they are not found in mountains, deserts and steppes.
Symptoms and signs of malaria
The incubation period for three days is 7-21 days, for four days it is 14-42 days, for tropical it is 6-16 days, and for oval it is 7-21 days.
Acute onset. Sometimes a prodromal period: malaise, aches, pain in the lower back, legs, back.
Fever attacks last up to 12 hours. Change of chills - heat phase - sweat phase with a frequency of 48-72 hours. In the interictal period, an improvement in well-being is observed. After three attacks, the liver and spleen are palpated. Hemolytic anemia, increased bilirubin. Mucous membranes and skin are pale yellow. Fever of intermittent nature. Then the skin becomes pale jaundiced. In severe conditions, hemorrhages may occur. During chills, the skin is pale and cold; during fever, it is dry, hot, and the face is hyperemic. When the temperature drops, profuse sweating occurs. Possible shortness of breath, impaired pulmonary ventilation, and blood circulation. During paroxysms: nausea, vomiting, flatulence, pain in the epigastric region. After three attacks, hepatosplenomegaly develops. In the tropical form - dyspepsia, decreased diuresis. With nephritis - increased blood pressure, edema, albuminuria, and possibly acute renal failure. In the tropical form, there may be hemoglobinuric fever: decreased diuresis, black or red urine. During paroxysms: headache, delirium, anxiety, agitation, sometimes a manifestation of a manic or depressive paranoid state. The pupillary reflex fades, patients do not react to external irritation, their eyes are closed and motionless. There may be meningeal symptoms and pathological reflexes, and there may be agitation. Possible coma: lethargy, deep sleep.
High fever and chills are replaced by sweating. Alternating daytime fever has been described but is rare.
Headache is an extremely common symptom. If there is a concomitant disturbance of consciousness or behavior, as well as convulsions, it is necessary to exclude hypoglycemia. The cerebral form of malaria manifests itself as coma. Retinal hemorrhage, drowsiness, and other neurological symptoms may be early signs of brain damage from malaria, which may progress later.
Abdominal symptoms: anorexia, pain, vomiting and diarrhea.
An attack of malaria usually lasts 6-10 hours or longer. In the interictal period, severe weakness is noted. After 3-4 attacks of malarial fever, the liver and spleen enlarge, sometimes myocardial dystrophy, acute transient nephritis and other pathological changes in organs develop. At the height of attacks, febrile delirium, vegetative neuroses and psychoses are possible.
Eye symptoms. Pathological changes are associated with both intoxication and developed anemia (the walls of blood vessels are damaged and multiple thromboses of the smallest vessels are formed). This manifests itself already at the first attack of fever with pinpoint and more extensive hemorrhages against the background of hyperemic conjunctiva. In patients with three-day malaria, the herpesvirus infection is activated, which is manifested by the occurrence of dendritic keratitis. In the fundus, spasm of the retinal vessels is detected with a violation of blood microcirculation in them and the phenomenon of endarteritis, retinal ischemia with preretinal and retinal hemorrhages. These changes are found in the central parts of the fundus.
In severe cases of malaria with coma, the optic nerves are involved in the pathological process in the form of bilateral optic neuritis.
In the chronic course of malaria, paralysis of accommodation, blepharitis, pigmentation and xerosis of the conjunctiva, pigmentation of the cornea and keratitis, iridocyclitis, choroiditis, and alternating strabismus develop.
Diagnosis based on:
- passport data (place of residence, profession);
- complaints - fever, its characteristics, frequency of attacks, sequence of appearance of clinical signs;
- history of the disease, life - acute onset, past illnesses;
- epidemic history - stay in areas with tropical and subtropical climates, blood transfusion;
- clinical data;
- OAK - anemia, leukopenia, neutropenia, coagulogram, hemoglobin;
- microscopy;
- OAM - proteinuria, cylindruria, albuminuria;
- serological studies: RNIF, enzyme-linked immunosorbent assay (ELISA), used in the examination of donors;
- studies of acid-base status;
- biochemical parameters.
Differential diagnosis - with typhoid fever, ARVI, pneumonia, Q fever, relapsing fever, pyelitis, pyelonephritis, perinephric abscess, cholecystitis, cholangitis, cholelithiasis, sepsis, hemolytic jaundice, leukemia, influenza, acute respiratory infections, viral hepatitis, pneumonia, brucellosis, arboviral diseases.
Malaria: laboratory and instrumental research methods
General blood analysis. Anemia, nonimmune hemolysis, leukopenia, and thrombocytopenia are suggestive of P. falciparum.
Glucose. Hypoglycemia may be observed with P. falciparum infection or intravenous quinine administration, especially during pregnancy
Urea, creatinine, liver function tests Acute renal failure and hemoglobinuria may occur in severe P. falciparum malaria.
Bacteriological blood test. Malaria may be accompanied by other infections, such as gram-negative sepsis.
Computed tomography of the brain and lumbar puncture. These studies may be required if there is a suspicion of cerebral malaria.
Arterial blood gases. Metabolic acidosis indicates severe malaria.
Malaria in children
All children sick with malaria can be divided into two large groups: those who fell ill for the first time, and those who developed malaria again. The first group usually includes children, the second group includes children over 10 years old. In the first group, malaria is much more severe, while the second group is at least slightly protected, albeit weak, by immunity.
In general, malaria in children is much more serious and aggressive than in adults. The main symptoms - attacks of fever - are the same: with 3-day malaria - every two days for 5-6 hours in a row, with 4-day malaria - every 3 days for 12 or more hours. Also characteristic are headaches, high fever, agitation, joint and muscle pain, thirst and, of course, bouts of severe chills, from which neither heating pads nor a warm bed can help. The attack ends with profuse sweating, weakness and drowsiness. Between attacks, the temperature remains at normal levels, the general condition is satisfactory.
The clinical appearance of symptoms is observed on the 8th to 15th day after infection, but may appear several months later. Small children who cannot explain what is happening to them become whiny, irritable, their appetite decreases, sleep is disturbed, their limbs become cold, and their skin turns pale. The decrease in temperature is accompanied by some sweating of the head and neck. In the initial period, the temperature of babies in some cases may be around normal, in others it starts sharply with an increase to 40 °C. In infants, there are practically no attacks of chills; instead, convulsions are observed.
As the disease progresses, the child becomes weaker and loses weight due to the development of anemia caused by the destruction of red blood cells. Moreover, the blood formula changes very quickly.
Malaria in pregnant women
It is very undesirable for pregnant women to suffer from this disease, as this is fraught with the loss of the child.
Spontaneous termination of pregnancy (miscarriages and stillborn children) with malaria occurs 3 times more often than usual. This is explained by the fact that the malarial plasmodium is able to overcome the placental barrier. The child dies in utero from intoxication, hypoglycemia, and anemia.
If maternal infection occurs late in pregnancy, the baby may be born alive, but still sick and at low birth weight. They develop jaundice, fever, and epileptic seizures, because the same unfavorable changes (destruction of red blood cells) occur in the child’s body as in an adult.
In early pregnancy and severe malaria, doctors often recommend termination of pregnancy, since the earlier the infection occurs, the worse it is for the fetus. In general, the outcome of the disease for the fetus depends not only on the timing of infection, but also on the state of health of the mother and the time of treatment.
The peculiarity of this disease in pregnant women is its severe atypical course due to anemia and an increased risk of malignant forms, fraught with serious complications on the liver and the appearance of malarial coma. Therefore, pregnant women should not travel to regions where they may be bitten by a malarial mosquito. And if such a trip cannot be avoided, it is necessary to undergo a course of preventive treatment.
During the standard course of the disease, pregnant women are treated according to a similar scheme as ordinary patients, since most drugs used for malaria are considered quite safe. In any case, the prevailing opinion among doctors is that the therapeutic results are more significant than the possible negative effects of medication. No matter how much discussion there is on this issue, the risk of developing fetal malaria in a child exceeds the level of danger from exposure to antimalarial drugs.
Treatment of malaria
If P. vivax is resistant to chloroquine, mefloquine or quinine is used.
Quinine is also used to treat chloroquine-resistant cases.
For oligoanuria, azotemia and hyperkalemia, plasma ultrafiltration or hemodialysis is prescribed.
Quinine orally, 600 mg every 8 hours, if signs of quinine overdose appear (nausea, tinnitus, deafness), the interval is increased to 12 hours. For 5-7 days until body temperature normalizes and if blood tests for the presence of the pathogen are negative, prescribe once 3 tablets of Fansidar (pyrimethamine and sulfadoxine) or if the pathogen is resistant to Fansidar (especially often observed in East Africa) or allergic to Fansidar, doxycycline is prescribed.
Complicated or severe P. falciparum malaria in adults
Mefloquine can also be effective, but resistance to it is more common, so it is recommended to consult with a malaria specialist about the choice of drug, including depending on the country in which the patient contracted malaria.
Antimalarial immunity
Despite the high contagiousness of malaria infection, not all people become ill with this disease, since some have innate immunity. Others develop acquired active or passive immunity.
Active immunity occurs after an illness. It is associated with the restructuring of the body, the production of specific antibodies, and an increase in the level of immunoglobulin. However, this immunity develops slowly, only after several months of repeated attacks, and is also unstable and short-lived. Newborns receive passive immunity from a mother who has antimalarial immunity, but it lasts only about three months.
The pathogenesis of hemorrhagic generalized capillary toxicosis is caused by obliteration (blockage) of blood vessels, disruption of the nutrition of nerve cells and brain tissue, followed by necrosis of the medulla and swelling of the meninges.
In addition to encephalitis itself, other disorders in the nervous system may appear, causing neuralgia, neuritis, radiculitis, polyradiculo-neuritis, serous meningitis, etc.
With malarial encephalitis, general cerebral disorders are observed in the form of speech impairment and coordination of movements, dizziness, headache, nausea, vomiting, etc., up to delirium and seizures similar to epileptic ones. Mental disorders can lead to disability. True, malarial psychoses practically do not occur during primary malaria; they are characteristic of repeated attacks.
Malarial encephalitis is treated in intensive care units of clinics, where detoxification, hormone therapy, neuroprotectors and other drugs are used.
With successful treatment of the primary disease, the signs of encephalitis almost safely disappear.
Specific and non-specific methods of protection
If you are planning a trip to a region that is epidemically unaffected by malaria, you should take preventive measures, that is, antimalarial drugs, and then avoid mosquito bites by using means of protection against blood-sucking mosquitoes.
If the trip does not take more than a month, a few days before departure and throughout the trip you should take 1 tablet of doxycycline daily. If you have to live longer in an unfavorable place, it is better to stock up on Lariam. You should start taking this drug a week before departure and then throughout the entire period, 1 tablet per week.
Most people know how to protect themselves from mosquito bites. First of all, repellents are used: sprays, ointments, lotions, and they must be applied not only to the skin, but also to clothes, shoes, backpacks, bags, etc.
Indoors, fumigators and mosquito nets on windows help fight insects.
If you have to spend the night outdoors, you need to use mosquito nets that are placed over the bed or over the sleeping bag.
Prevention of malaria
If it can be very difficult to get rid of mosquitoes, then in epidemically unfavorable areas the population is recommended to protect themselves from blood-sucking mosquitoes individually: wear appropriate clothing, use repellent creams and sprays, and cover their faces with a mosquito net.
You can protect yourself from the development of plasmodium inside the body through preventive measures. There are special medications that are used if you are planning to travel to areas that are dangerous for the development of malaria. The course of taking them begins 2 weeks before and a month after an epidemically disadvantaged place.
Typically, the same drugs are used for prevention as for treatment, but different, smaller doses and a different regimen are used. In the future, doctors take into account the fact that if some drug was used for prevention and did not give an effect (that is, the person still got sick), then this medication is no longer useful to then prescribe as a medicine. Combinations with artemisinin and quinine are not used for prevention.
There is no vaccine to prevent malaria infection yet, although active work is constantly underway to create one, and there are already some promising intermediate results.
Depending on the type of malaria, the presence or absence of complications of the disease, the stage of the development cycle of malarial plasmodium, the presence of resistance (resistance) to antimalarial drugs, individual regimens of etiotropic therapy are developed from the presented antimalarial drugs.
| Drug group | Drug names | Mechanism of action | Efficacy against malaria species | Reception mode |
| Quinolylmethanols | Quinine
(quinine sulfate, quinine hydrochloride and dihydrochloride, quinimax, hexaquin) | Hematoschizotropic antimalarial drugs
effective against plasmodia during the period of erythrocyte schizogony. Prevents the penetration of plasmodia into red blood cells. Gametocidal drug acts on gametocytes (sexual forms), prevents further entry of plasmodium into the mosquito’s body. | All types of plasmodium, including those resistant to chloroquine. | Adults
– 2 g/day. for 3 doses orally, 20-30 mg/kg/day. in 2-3 doses intravenously, 3-7 days. Children – 25 mg/kg in 3 doses, 3-7 days. |
| Chloroquine (delagil, hingamin) | Hematoschisotropic and moderate gametocidal action. | All types of plasmodia. | Adults
– 0.5 g/day. orally, 20-25 mg/kg in 3 injections every 30-32 hours intravenously. Children – 5 mg/kg/day 2-3 days. |
|
| Hydroxychloroquine (plaquenil) | Hematoschisotropic and moderate gametocidal action. | All types of plasmodia. | Adults
– 0.4 g/day. inside 2-3 days. Children – 6.5 mg/kg/ days 2-3 days. |
|
| Mefloquine (lariam) | Hematoschisotropic action | | Adults:
first dose – 0.75, after 12 hours – 0.5 g. Children – first dose – 15 mg/kg, after 12 hours – 10 mg/kg. |
|
| Primaquin | Histoschizotropic drug acts on tissue schizonts of plasmodia, incl. and on hypnozoites (dormant forms). Effective for preventing relapses. Gametocidal action. | Three-day and oval malaria. | Adults:
2.5 mg/kg every 48 hours – 3 doses. Children: 0.5 mg/kg every 48 hours – 3 doses. |
|
| Biguanides | Proguanil (bigumal, paludrin) | Histoschisotropic action . Slow hematoschizotropic action. | Tropical malaria, including those resistant to quinine and chloroquine. | Adults:
0.4 g/day. 3 days. Children: 0.1 – 0.3 g/day. 3 days |
| Diaminopyrimidines | Pyrimethamine (chloridine, Daraprim) | Histoschisotropic action . Slow hematoschizotropic action in combination with sulfadoxine. | Tropical malaria. | Adults:
0.075 g once. Children: 0.0125 – 0.05 g once. |
| Terpene lactones | Artemisinin (artemeter, artesunate) | Hematoschisotropic
action. Reserve drug | All types of malaria. | Adults and children:
first dose – 3.2 mg/kg, then 1.6 mg/kg 1-2 times a day for 5-7 days. |
| Hydroxynaphthoquinones | Atowahon (mepron) | Hematoschisotropic
action. Reserve drug, used in the presence of resistance to other drugs. | All types of malaria. | Adults:
0.5 g 2 times a day for 3 days. Children: 0.125-0.375g 2 times a day for 3 days. |
| Sulfonamides | Sulfadoxine | Hematoschisotropic | Tropical malaria. | Adults:
1.5 g once. Children: 0.25 – 1.0 g once. |
| Sulfones | Dapsone | Hematoschisotropic action in combination with pyrimethamine. | Adults:
0.1 g/day. Children: 1-2 mg/kg/day. |
|
| Tetracyclines | Tetracycline | Hematoschisotropic histoschisotropic action. | Tropical malaria, resistant to the above drugs. | Adults:
0.3 – 0.5 g 4 times a day. Children over 8 years old: 25-50 mg/kg/day. |
| Lincosamides | Clindamycin | Hematoschisotropic
action, low activity, moderate histoschisotropic action. | Tropical malaria, resistant to the above drugs, low activity. | Adults:
0.3 – 0.45 g 4 times a day. Children over 8 years old: 10-25 mg/kg/day. |
Caring for a person with malaria
A person suffering from malaria requires constant and careful care to reduce suffering during attacks of fever. During the period of chills, it is necessary to cover the patient; you can put heating pads at the feet. During a fever, it is necessary to open the patient, remove heating pads, but prevent hypothermia and drafts. For headaches, you can put a cold pack on your head. After profuse sweating, change the underwear and give the patient rest.
In the room where the patient is located, it is necessary to prevent the entry of mosquitoes (use of nets, insecticides) in order to prevent the spread of malaria.
If complications of malaria occur, the patient is transferred to a ward or intensive care unit.
Diet for malaria
- Interictal period– no diet is prescribed, common table No. 15 with plenty of drink.
- During an attack of fever – table No. 13 with plenty of drink. Table No. 13 provides for increasing the body's defenses; meals should be frequent and divided.
- low-fat varieties of fish and meat, low-fat broths,
- boiled eggs,
- dairy products,
- mashed rice, buckwheat and semolina porridge,
- boiled vegetables,
- stale wheat bread, crackers,
- ground soft fruits and berries,
- juices, fruit drinks, decoctions,
- honey, sugar.
Prevention of malaria
Prevention of malaria is necessary when living or temporarily staying in countries where malaria is endemic. So, when traveling to a malaria-prone country, you need to prepare in advance. It is advisable for pregnant women, children under 4 years of age and people living with HIV not to travel to countries affected by malaria. Protection against mosquito bites
- Mosquito nets on windows and doorways, you can sleep under a mesh curtain, tucking it under the mattress.
- Repellents– chemical compounds that repel mosquitoes, but do not kill them, which are applied to human skin or clothing. There are various forms: creams, sprays, aerosols, gels, etc. Use according to the instructions.
- Insecticides– means for killing mosquitoes. It is recommended to treat rooms, nets, and thresholds with an insecticide aerosol. Half an hour after treatment, it is necessary to ventilate the room.
Drug prevention of malaria
Antimalarial drugs are used. It is necessary to clarify the regional resistance of malaria to drugs. Drug prevention does not provide 100% protection, but significantly reduces the risk of disease.Drugs used to prevent malaria(must start 1 week before travel and continue for 4 – 6 weeks after arriving home) :
- Chloroquine (delagil) 0.5 g for adults and 5 mg/kg/day. children once a week.
- Hydroxychloroquine (Plaquenil) 0.4 g for adults and 6.5 mg/kg for children once a week.
- Mefloquine (Lariam) 0.25 g for adults and 0.05 - 0.25 mg for children once a week.
- Primaquin 30 mg for adults and 0.3 mg/kg for children once every 48 hours.
- Proguanil (bigumal) 0.2 g/day. adults and 0.05-0.2 g for children.
- Primethamine (chloridine) 0.0125 g for adults and 0.0025 – 0.0125 g for children in combination with the drug dapsone 0.1 g for adults once a week.
Identifying and effectively treating patients with malaria
It is necessary to promptly examine patients with suspected malaria, and also be sure to examine patients with each hyperthermic syndrome who arrived from places where malaria is endemic for 3 years. Effective treatment helps stop further transmission of the pathogen through mosquitoes.Malaria vaccine
There is currently no official malaria vaccine. However, clinical studies of an experimental vaccine against tropical malaria are underway. Perhaps, in 2015 - 2017, this vaccine will help cope with the malaria epidemic in the world.
What is lip malaria and how does it manifest?
Malaria on the lips manifests itself in the form of small blisters, located close to each other and filled with clear liquid. The cause of such lesions on the skin is the herpes simplex virus type 1. Therefore, the use of the term “malaria” to refer to this phenomenon is not correct. Also among the popular designations for the herpes virus on the lips there are such terms as “cold” or “fever on the lips”. This disease manifests itself with local symptoms that develop in accordance with a certain pattern. In addition to local symptoms, patients may also be concerned about some general manifestations of this disease. The stages of manifestation of herpes on the lips are:
- tingling;
- bubble formation;
- formation of ulcers;
- scab formation;
- healing.
The initial stage of herpes on the lips is manifested by mild itching. The patient begins to experience a slight tingling sensation in the corners of the mouth, on the inner and outer surfaces of the lips. Along with tingling, the patient may be bothered by the desire to scratch the areas around the wings of the nose or other parts of the face. Sometimes language can be involved in this process. The duration of this stage most often does not exceed 24 hours. These symptoms may occur due to overheating or hypothermia of the body. Often, herpes on the lips is a harbinger of a cold. In women, this phenomenon can develop during menstruation.
Bubble Formation
At this stage, the inflammatory process begins to develop. The areas where tingling was felt swell and small transparent bubbles form on their surface. The vesicles are located tightly to each other, forming small clusters. These formations are filled with a clear liquid, which becomes more cloudy as they grow. The pressure in the blisters increases and they become very painful. The location of the bubbles is the upper or lower lip, as well as areas under the nose.
Formation of ulcers
After 2–3 days, the bubbles with liquid begin to burst. During this period, the patient is most contagious, since the fluid contains a large number of viruses. An ulcer forms at the site of the burst vesicle.
Formation of scabs
At this stage, the ulcers begin to become covered with a brown crust. All affected areas are involved in the process, and within one day dried scabs form in place of the blisters. When removing the crust, bleeding wounds and a feeling of itching or burning may occur.
Healing
Within 4–5 days, wound healing and skin restoration occur. During the process of the scab falling off, the patient may be bothered by mild peeling and itching, which often provokes patients to peel off the crust of the ulcers on their own. This leads to the healing process being delayed. Such interference can lead to the addition of a bacterial infection.
Common manifestations of herpes on the lips
Along with rashes in the lip area, herpes simplex type 1 can be manifested by a deterioration in general condition, weakness, and headache. Often, patients have enlarged lymph nodes located in the lower jaw. Body temperature may also rise, muscle pain may develop, and salivation may increase.
What types of malaria are there?
There are four main types of malaria. Each type is caused by a specific type of malarial plasmodium, which determines the specificity of the disease. The types of malaria are:
- tropical malaria;
- three-day malaria;
- malaria ovale;
- quartan.
Tropical or, as it is also called, comatose malaria has the most severe course. It accounts for about 95–97 percent of all deaths. The clinic is dominated by severe toxic syndrome. The changes in the phases of “chills,” “heat,” and “sweat,” characteristic of other forms of malaria, are not expressed.
The disease begins with the appearance of fever, diffuse headache and myalgia ( severe muscle pain). After a couple of days, symptoms of toxic syndrome appear - nausea, vomiting, low blood pressure. Tropical malaria is characterized by the appearance of a rash on the body ( allergic exanthema), cough, feeling of suffocation. During the first week, hemolytic anemia develops, which is accompanied by the development of jaundice. Anemia develops due to increased destruction ( hemolysis – hence the name anemia) red blood cells. Enlargement of the liver and spleen is observed only in the second week, which significantly complicates the early diagnosis of malaria.
Many people with weakened immune systems may develop toxic shock, malarial coma, or acute renal failure already in the first or second week of the disease. Patients who develop a malarial coma become lethargic, sleepy, and apathetic. After a few hours, consciousness becomes confused, inhibited, and convulsions may also appear. This condition has an unfavorable outcome.
Due to massive destruction of red blood cells, acute renal failure most often develops. So, from destroyed red blood cells, hemoglobin enters first into the blood and then into the urine. As a result, the processes of urine formation in the kidneys are disrupted and diuresis decreases ( daily urine). Due to oliguria, metabolic products that are normally excreted in the urine remain in the body. A condition called uremia develops.
Three-day malaria
Three-day malaria is a benign type of malarial invasion. As a rule, it is not accompanied by severe complications and does not lead to death.
Its onset is preceded by a short prodromal period, which is absent in the tropical species. It manifests itself as weakness and muscle pain, after which a sudden fever appears. The difference between three-day malaria is that temperature rises occur every 48 hours, that is, every third day. This is where the name of this type of malaria comes from. During the period of rising temperature, patients are excited, breathing heavily, their skin is hot and dry. Heart rate is sharply increased ( up to 100 – 120 beats per minute), blood pressure drops, and urinary retention develops. The phases of “chills,” “heat,” and “sweat” become more distinct. The average duration of an attack varies from 6 to 12 hours. After two to three attacks ( respectively on days 7 – 10) an enlarged liver and spleen appear, and jaundice develops.
However, it can also happen that attacks of fever occur every day. This phenomenon is due to the entry into the blood of several generations of malarial plasmodium at once. Several months after the illness, the patient may continue to have periodic rises in temperature.
Malaria oval
This type of malaria is in many ways similar to tertian malaria, but has a milder course. The difference between malaria ovale is that attacks of fever occur every other day. The temperature rises mainly in the evening hours, which is not typical for previous types of malaria.
Quartan
This type of malaria, like the previous one, belongs to the benign forms of malarial invasion. It develops acutely, without any prodromal phenomena. Fever attacks occur every 72 hours. The temperature rises to 39 - 40 degrees. During attacks, the patient is also in serious condition - consciousness is confused, the skin is dry, the tongue is coated, blood pressure drops sharply.
In addition to the classic types of malaria, there is also a schizont type. It develops as a result of ready-made schizonts entering the human blood ( plasmodia that have undergone an asexual development cycle). Schizont malaria mainly develops as a result of blood transfusions or through the transplacental route. Therefore, this type is also called syringe or graft. Its difference is the absence of the development phase of plasmodium in the liver, and the clinical picture depends entirely on the volume of blood administered.
Mixed malaria also occurs, which develops as a result of simultaneous infection with several types of malarial plasmodia.
What are the features of tropical malaria?
The main features of tropical malaria are the severity of the developing symptoms, the nature of which is similar for all forms of the disease. There are also some differences between the complications, duration and outcome of tropical malaria from other types of disease. Onset of the disease
Malaria is characterized by a prodromal period ( mild course of the disease), which is characterized by general malaise and mild headaches. Feverish states typical for this disease, followed by periods of calm ( paroxysms), occur after 2–3 days. In tropical malaria, the onset of the disease is more acute. From the first days, patients begin to experience nausea, vomiting, and indigestion in the form of diarrhea. Headaches vary in intensity. These symptoms are accompanied by a persistent fever that can last for several days. Subsequently, the fever acquires an intermittent course with other phases of paroxysms.
Features of tropical malaria from other forms
| All forms of malaria except tropical | Criteria | Tropical malaria |
| The attacks are characterized by a clear change in phases of chills, heat and sweat. The duration of the second stage rarely exceeds 12 hours. After the end of the heat, body temperature drops sharply and increased sweating begins. Seizures occur according to a certain pattern. So, with three-day malaria, paroxysm bothers the patient once every 3 days, with four-day malaria - once every four days. | Paroxysms | The difference between paroxysms in this form is the short duration and weak severity of the first phase ( chills). In some cases, attacks begin to develop from the fever stage, bypassing the chills. In this case, the temperature suddenly reaches high values ( above 40 degrees) and can last all day. There is no specific systematic pattern in the occurrence of attacks. They can occur every other day, daily or twice a day. A decrease in temperature can occur without heavy sweating. |
| The patient may not feel anemia and this symptom is in most cases detected during laboratory testing. Sometimes blood changes are manifested by pale skin and weakness. | Anemia | With tropical malaria, anemia is more pronounced. Blood tests can detect pathologies from the first days of the disease. Patients experience lethargy and apathy due to a reduced amount of hemoglobin. There is a bluish tint to the extremities. |
| The spleen increases in size after several attacks. In this case, the abdomen becomes large and palpation can reveal a twofold increase in this organ. | Enlarged spleen | This form of malaria is characterized by a rapid enlargement of the spleen, which can be detected by ultrasound as early as 2–3 days. In this case, patients complain of pain in the area of the right hypochondrium, which becomes stronger with a deep sigh. |
| With malaria, there is an enlargement of the liver, which entails nausea and pain, which is localized in the right hypochondrium. Liver functions are not significantly impaired, but yellowness of the skin and mucous membranes is present. A change in the size of this organ occurs after the first attacks and leads to a 10–15 percent increase in the total mass of the organ. | Liver enlargement | In tropical malaria, liver enlargement is more progressive. Also, this form is characterized by liver damage, which entails damage to the hepatic lobules ( liver functional units). |
| With malaria infection, there is a decrease in blood pressure during the fever phase and a slight increase during the chills stage. Patients also complain of rapid heartbeat and pain in the heart area, which are stabbing in nature. | Pathologies of the cardiovascular system | Tropical malaria is manifested by severe hypotension ( decreased blood pressure). In addition, there are severe heart pains, murmurs, and tachycardia. |
| During attacks, patients experience headaches and motor agitation. Feverish delirium may occur. In most cases, these symptoms go away as the temperature normalizes. | Nervous system disorders | Tropical malaria is characterized by more pronounced damage to the nervous system. Severe headaches, feelings of anxiety and restlessness, convulsions, and confusion are often observed. |
| Malaria may be accompanied by a disorder such as albuminuria ( increased protein excretion in urine). Often, kidney dysfunction provokes edema. Such violations are quite rare - in 2 percent of cases. | Kidney dysfunction | With this form, kidney dysfunction is diagnosed in 22 percent of patients. |
Complications
Severe complications, which often result in the death of the patient, most often develop with tropical malaria.
Complications of tropical malaria are:
- malarial coma– the patient’s unconscious state with a complete lack of reaction to any stimuli;
- algid– toxic-infectious shock, in which the patient retains consciousness, but remains in prostration ( severely depressed and indifferent state);
- hemoglobinuric fever– development of acute renal and liver failure.
The duration of this form of malaria differs from other types of the disease. Thus, the total duration of three-day malaria varies from 2 to 3 years, four-day malaria - from 4 to 5 years, oval malaria - approximately 3 - 4 years. The duration of tropical malaria does not exceed, in most cases, one year.
What are the signs of malaria in adults?
The main symptom of malaria in adults is attacks of fever ( paroxysms) giving way to a state of rest. They are characteristic of all forms of the disease, except tropical malaria. Before the first attack, the patient may experience a headache, pain in the muscles and joints, and general malaise. Body temperature may also rise to subfebrile levels ( no higher than 38 degrees). This condition continues for 2–3 days, after which febrile paroxysms begin. Malarial attacks are characterized by the presence of phases that develop and replace each other in a certain sequence. At first, the attacks may be irregular in nature, but after a few days a clear pattern of development of this symptom is established. The duration of pauses between attacks depends on the form of the disease. With three-day malaria, the attack repeats once every 3 days, with four-day malaria - once every 4 days. Attacks develop at the same time, most often between 11 and 15 hours. The phases of a malarial attack are:
- chills;
This stage can be manifested by both mild trembling and severe chills, from which the patient’s whole body shakes. At the same time, the patient’s hands, feet and face become cold and acquire a bluish tint. The pulse quickens and breathing becomes shallow. The skin turns pale, becomes rough and takes on a bluish color. Chills can last from half an hour to 2 – 3 hours.
Heat
This phase is accompanied by a sharp increase in temperature, which can reach above 40 degrees. The patient's condition noticeably worsens. The face becomes red, the skin becomes dry and hot to the touch. The patient begins to experience severe headaches, muscle heaviness, and rapid, painful heartbeat. The tongue is covered with a grayish coating and is not sufficiently moist. Often the fever stage is accompanied by vomiting and diarrhea. The patient is in a state of excitement, convulsions and loss of consciousness may occur. The heat provokes an unquenchable thirst. This condition can last from 5 – 6 to 12 hours.
Sweat
The heat stage is replaced by the final phase, which is manifested by profuse sweating. The temperature drops sharply to normal values, sometimes reaching 35 degrees. The patient feels relief, calms down and falls asleep.
Other signs of malaria
Along with attacks, the most characteristic signs of malaria include anemia ( anemia), splenomegaly ( enlarged spleen) and hepatomegaly ( liver enlargement). This disease also has a number of symptoms that manifest themselves both on the physical and mental levels.
Signs of malaria include:
- anemia;
- splenomegaly;
- hepatomegaly;
- urinary disorders;
- dysfunction of the cardiovascular system;
- icteric staining of the skin and mucous membranes;
- skin hemorrhages;
- herpetic rashes ( manifestations of herpes);
- nervous disorders.
In patients with malaria, anemia sharply develops, which is characterized by a deficiency of hemoglobin and red blood cells. It develops due to massive destruction of red blood cells, due to the presence of malarial plasmodium in them ( so-called hemolytic anemia). Signs of anemia are most obvious between attacks. However, anemia may persist for a long time after recovery. The patient's skin becomes yellowish or sallow in color, weakness and increased fatigue are noted. With anemia, body tissues experience severe oxygen deficiency, because hemoglobin is an oxygen carrier.
Splenomegaly
An enlarged spleen is observed after 3–4 attacks of fever and persists for a long time. In tropical malaria, the spleen may enlarge immediately after the first paroxysm. Along with the increase, pain in this organ is observed. The spleen becomes denser, which is determined by palpation. In the absence of adequate treatment, the spleen enlarges so much that it begins to occupy the entire left side of the abdomen.
Hepatomegaly
The enlargement of the liver occurs faster than the change in the spleen. In this case, the edge of the liver drops below the costal arch and becomes denser and more painful. The patient complains of painful discomfort in the area of the right hypochondrium.
Urinary disorders
Against the background of ongoing processes in the body, during attacks during chills, patients experience frequent urination. In this case, the urine has an almost transparent color. With the onset of fever, the volume of urine becomes more scanty, and the color becomes darker.
Dysfunction of the cardiovascular system
The most severe disturbances of the cardiovascular system are expressed during malarial paroxysms. Characteristic signs of this disease are an increase in blood pressure during chills and a drop during fever.
Jaundice staining of the skin and mucous membranes
It is an early sign of malaria in adults. When red blood cells are destroyed, not only hemoglobin is released from them, but also bilirubin ( bile pigment). It gives the yellow color to the skin and mucous membranes. In people with dark skin color, it is sometimes difficult to detect icteric discoloration. Their jaundice is determined by the color of the visible mucous membranes, namely the sclera ( outer shell of the eye). The yellowish color of the sclera or their icterus may appear long before the icteric discoloration of the skin, and therefore is an important diagnostic sign.
Skin hemorrhages
Due to vascular spasms, a hemorrhagic rash forms on the patient’s body ( subcutaneous hemorrhages). The rash has no specific localization and spreads unevenly throughout the body. Externally, this sign looks like star-shaped spots of blue, red or purple.
Herpetic rashes
If a patient with malaria is a carrier of the herpes virus, it worsens during a febrile state. Bubbles with clear liquid characteristic of the virus appear on the lips, wings of the nose, and less often on other areas of the face.
Nervous disorders
The most obvious disorders of the nervous system are manifested in three-day and tropical malaria. Patients experience constant headaches, insomnia, and lethargy in the morning and throughout the day. The psyche of patients undergoes negative changes during attacks. They are depressed, have poor orientation, and answer questions asked in a confused manner. Often during a fever, patients become delirious and experience hallucinations. Tropical malaria is characterized by a violent state of the patient, which can continue even after an attack.
What are the signs of malaria in children?
In children, the signs of malaria vary widely, depending on the child’s age and immune system. Signs of malaria in children include:
- fever;
- anemia;
- rash;
- disorders of the gastrointestinal tract;
- disorders of the nervous system;
- convulsions;
- enlargement of the spleen and liver.
It is the main symptom of childhood malaria. It can be either constant or in the form of attacks. Classic attacks, which are typical for adults, are rare. Such attacks occur in several stages. The first stage is chills; the second is heat ( heat); the third is pouring sweat. Children are characterized by high temperature rises of up to 40 degrees or more. The younger the child, the stronger the fever. During the second stage, children are excited, they experience rapid breathing, dry and red skin. A drop in temperature is accompanied by heavy sweating and severe, debilitating weakness. Such classic seizures are rare in children. More often, the temperature is variable, and in 10–15 percent of children, malaria occurs without fever at all. Infants often experience constant fever, drowsiness, and lethargy. The equivalent of an attack in infants is a sharp pallor of the skin, turning into cyanosis ( bluish discoloration of the skin). In this case, the skin becomes sharply cold, and tremors of the limbs are observed.
Anemia
As a rule, malaria in children occurs with severe anemia. It appears from the first days of the disease and is often an early diagnostic sign. It develops due to massive destruction of red blood cells. The number of red blood cells sometimes drops to 30–40 percent of normal.
A distinctive sign of malarial invasion in children is changes in the blood not only in red blood cells and hemoglobin, but also in other blood elements. Thus, very often there is a general decrease in leukocytes ( leukopenia), platelets. At the same time, the erythrocyte sedimentation rate increases. Despite severe anemia, jaundice in children with malaria is observed only in 15 to 20 percent of cases.
Rash
The rash is especially common in young children. It first appears on the abdomen, then spreads to the chest and other parts of the body. The nature of the rash can be very diverse - petechial, macular, hemorrhagic. The development of the rash is caused by a decrease in the number of platelets and increased permeability of the vascular wall.
Gastrointestinal disorders
Disorders of the digestive system are almost always noted. The younger the child, the more varied these disorders are. They manifest themselves in the form of diarrhea, repeated vomiting, and nausea. Loose stools mixed with mucus are often observed, which is accompanied by bloating and pain. In infants, this may be the first sign of malarial infestation. Repeated vomiting also occurs, which does not bring relief.
Nervous system disorders
They can appear both at the height of febrile attacks and during the temperature-free period. These disorders manifest themselves in the form of meningeal symptoms, which are characteristic of all types of malaria. Photophobia, stiff neck, and vomiting appear. Such symptoms disappear simultaneously with a drop in temperature. Motor agitation, delirium, and confusion may also occur. This variety of nervous system disorders is explained by the effect of malaria toxin on nerve cells.
Convulsions
Seizures or convulsions are also very common in children with malaria. Basically, cramps appear at the height of fever. They can be clonic or tonic. Their appearance is explained by high temperature, and not by the presence of any disease. These seizures belong to the category of febrile seizures, which are characteristic of childhood. The younger the child, the more likely he is to have seizures.
Enlarged spleen and liver
It is a common but inconsistent symptom. The spleen and liver enlarge only after several repeated attacks of fever.
A separate type of malarial infection in children is congenital malaria. In this case, malarial plasmodium enters the child's body in utero through the placenta. This malaria is extremely severe and often ends in death. Children with congenital malaria are born prematurely, with low weight and abnormalities of internal organs. The skin of such children is pale, with a waxy or jaundiced tint, and a hemorrhagic rash is often observed. The spleen and liver are sharply enlarged. When born, children do not make their first cry, they are usually lethargic, with reduced muscle tone.
Why is malaria dangerous during pregnancy?
The danger of malaria during pregnancy is the increased risk of developing malignant forms of the disease. Physiological changes that accompany the process of bearing a child make a woman more susceptible to infection. The nature of the consequences is determined by the stage of pregnancy at which malaria infection occurred. The outcome of the disease is also influenced by the condition of the woman’s body and the timing at which treatment was started. Infectious agents can have a negative impact both on the pregnant woman and directly on the fetus itself. Consequences of malaria for women
The infection poses the greatest danger if it is contracted in the early stages of pregnancy. The most common consequence is spontaneous abortion. Termination of pregnancy occurs due to irreversible changes that have occurred in a woman’s body under the influence of malarial plasmodia. If pregnancy continues, children are often born prematurely, of which 15 percent die during childbirth and 42 percent die in the first days after birth. Among full-term children born to women infected with malaria, the percentage of stillbirths is an order of magnitude higher than among other mothers. Often, children of patients with malaria are born with low birth weight and are often ill during the first years of life.
Complications of malaria during pregnancy are:
- anemia (there is anemia among the people);
- nephropathy (a form of late toxicosis caused by kidney dysfunction);
- eclampsia (critical complications due to brain damage);
- hypoglycemia (decreased blood sugar).
Lack of hemoglobin in the blood provokes multiple pathological processes in a woman’s body. The liver stops producing the necessary amount of protein to form new cells, which can result in intrauterine developmental delay of the embryo. Toxins are no longer excreted in full, which can lead to insufficient oxygen supply to the fetus.
Other consequences of malaria due to anemia are:
- premature placental abruption;
- stillbirth;
- weakness of labor.
Nephropathy develops after the 20th week of pregnancy and is manifested by increased blood pressure, swelling of the hands and face, insomnia and headaches. Laboratory tests for this disorder detect increased levels of protein and uric acid in the urine. The consequences of nephropathy can be intrauterine growth retardation, pregnancy loss, and fetal death.
Eclampsia
This disorder develops due to damage to brain cells caused by malaria infection. Eclampsia manifests itself as convulsive seizures, after which the patient falls into a coma. After some time, the patient returns to consciousness. In some cases, a prolonged coma may develop, from which the woman cannot emerge. Vascular spasms that occur during seizures can lead to asphyxia ( suffocation) or hypoxia ( oxygen starvation) embryo. Eclampsia often causes intrauterine fetal death. In a pregnant woman, this complication of malaria can cause stroke, heart or lung failure, liver or kidney dysfunction. Often, against the background of this disorder, premature placental abruption occurs. All these pathologies can lead to the death of both the fetus and the woman herself.
Hypoglycemia
This syndrome can develop in pregnant women infected with tropical malaria. Hypoglycemia manifests itself in attacks, the repeated repetition of which can harm both the fetus and the expectant mother. The lack of the required amount of glucose can cause heartbeat disturbances or retardation in physical and mental development in the embryo. For women, this condition is fraught with depression of cognitive functions, depression, and attention disorders.
Also the consequences of congenital malaria include:
- jaundice;
- epileptic seizures;
- anemia ( often in severe form);
- enlarged liver and/or spleen;
- increased susceptibility to infections.
What drugs are there against malaria?
Against malaria, there is a wide range of different drugs that act on different stages of the development of Plasmodium falciparum. First of all, etiotropic drugs are used, the action of which is aimed at destroying the malarial plasmodium from the body. Drugs whose action is aimed at eliminating symptoms ( symptomatic treatment).There are the following main groups of drugs against malaria:
- drugs that act on malarial plasmodia in the liver and that prevent their further penetration into red blood cells - proguanil, primaquine;
- drugs that act on erythrocyte forms of plasmodium, that is, those that are already in erythrocytes - quinine, mefloquine, atovaquone;
- drugs that act on the sexual forms of Plasmodium falciparum - chloroquine;
- drugs to prevent relapses of malaria - primaquine;
- drugs used to prevent malaria - plasmocide, bigumal.
- drugs that are used to both treat and prevent malaria are antifolates.
Main drugs used in the treatment and prevention of malaria
| A drug | Characteristic |
| Chloroquine | Mainly used for the prevention of all types of malaria. The drug should be taken a week before entering an endemic zone ( country or region with a high incidence of malaria). |
| Mefloquine | Used to prevent malaria in cases where chloroquine is ineffective. |
| Quinine | It is used in the treatment of malignant forms of malaria, for example, in the tropical form. The drug may be contraindicated due to individual intolerance. |
| Proguanil | They are used in the treatment of malaria in combination with other drugs, such as atovaquone. Also used for prevention. |
| Pyrimethamine | It has a wide spectrum of action and is effective against malarial plasmodium and toxoplasma. Rarely used in monotherapy, as it quickly causes resistance. |
| Atovaquone | Used in the treatment of malaria, but not registered in most CIS countries. Highly effective against all types of malaria, used in the treatment of malaria in AIDS patients. |
| Galfan | It is a reserve drug and is used in extreme cases for forms of malaria resistant to other drugs. It also has great cardiotoxicity. |
There are other drugs used in the treatment of malaria:
- antihistamines – clemastine, loratadine;
- diuretics – furosemide, diacarb, mannitol;
- colloidal and crystalloid solutions - refortan, 20 and 40% glucose solution;
- cardiotonic drugs – dopamine, dobutamine;
- glucocorticoids – Avamis, beclazone;
What anti-malaria pills are there?
There are different anti-malaria tablets depending on the main active ingredient. | Name of tablets | Characteristic | ||||||
| Quinine sulfate | Take 1 - 2 grams per day, lasting 4 - 7 days. They can be found in the form of 0.25 gram and 0.5 gram tablets. The daily dose is divided into 2 – 3 doses. The tablets should be taken with acidified water. It is best to use water with lemon juice. The dose and duration of taking the tablets depends on the type of malaria. Children's doses depend on age. |
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| Chloroquine | Adults are prescribed 0.5 grams per day. On the first day, the daily dose was increased to 1.5 grams in two doses - 1.0 and 0.5 grams. Children's doses are 5 – 7.5 milligrams per kilogram. Treatment with chloroquine lasts 3 days. |
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| Hydroxychloroquine | Adults are prescribed 0.4 grams per day. On the first day, the daily dose was increased to 1.2 grams in two doses - 0.8 and 0.4 grams. Children's doses are 6.5 milligrams per kilogram. Treatment with hydroxychloroquine tablets lasts 3 days. |
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| Primaquin | Available in 3 and 9 milligrams. They are taken at 27 milligrams per day for two weeks. The daily dose is divided into 2 – 3 doses. Proguanil is prescribed not only for therapy, but also for the prevention of malaria. The dosage depends on the type of malaria. On average, the daily therapeutic dose is 0.4 grams, and the prophylactic dose is 0.2 grams. Treatment lasts 3 days, and prophylaxis lasts the entire period of stay in an area with a high risk of infection, plus another 4 weeks. Children's doses do not exceed 0.3 grams per day. Diaminopyrimidine group of drugs Sulfanilamide group of drugs Sulfones Tetracycline group of drugs and lincosamides
What tests for malaria need to be taken? For malaria, it is necessary to take a general urine test, as well as general and specific blood tests that will help diagnose this disease. General urine analysis Hemoleukogram All blood tests begin with a hemoleukogram. In malaria, red blood cells are destroyed in large numbers, which leads to shifts in the overall ratio of cellular elements in the blood. The main deviations in the hemoleukogram in malaria are:
For malaria, it is also necessary to take a biochemical blood test, which confirms the active destruction of red blood cells in the vascular bed. Immunological blood test Polymerase chain reaction based on a drop of blood What are the stages of malaria? The clinical picture of malaria is divided into several stages. The stages of malaria are:
The incubation period is the period of time from the moment the malarial plasmodium enters the body until the first symptoms appear. The duration of this period depends on the type of malarial plasmodium. The duration of the incubation period depending on the type of malaria The length of the incubation period may vary if inadequate prevention has previously been taken. Stage of primary manifestations During periods of no fever, symptoms such as muscle pain, headaches, weakness, and nausea persist. If malaria develops in children, then during this period symptoms of gastrointestinal disorders predominate. These symptoms are vomiting, diarrhea, and bloating. As the liver enlarges, a dull pain in the right hypochondrium increases and jaundice develops, as a result of which the patients’ skin acquires a jaundiced tint. One of the most formidable symptoms of this period is rapidly developing anemia ( decrease in the number of red blood cells and hemoglobin in the blood). Its development is caused by the destruction of red blood cells by the malarial plasmodium. Red blood cells are destroyed, and hemoglobin comes out of them ( which subsequently appears in the urine) and bilirubin, which gives the skin its yellow color. Anemia, in turn, leads to other complications. This is, firstly, oxygen deficiency that the body experiences. Secondly, hemoglobin released from red blood cells enters the kidneys, disrupting their functionality. Therefore, acute renal failure is a common complication of this period. It is also the main cause of death from malaria. This stage characterizes the main clinical picture of malaria. In case of untimely diagnosis and treatment, conditions such as malarial coma, toxic shock, and hemorrhagic syndrome develop. Toxic syndrome at this stage is moderate, complications are rare. As in the stage of early manifestations, anemia develops, the liver and spleen are moderately enlarged. Recovery stage Sometimes a latent stage may occur between the periods of early and late relapses ( complete absence of symptoms). It can last from two to ten months and is mainly characteristic of three-day malaria and malaria ovale. What are the consequences of malaria? There are multiple consequences of malaria. They can occur both in the acute period of the disease ( that is, in the stage of early manifestations), and after. The consequences of malaria are:
As a rule, it is a complication of tropical malaria, but can also be a consequence of other forms of malarial invasion. This complication is characterized by a staged, but at the same time, rapid course. Initially, patients complain of severe headache, repeated vomiting, and dizziness. They experience lethargy, apathy and severe drowsiness. Over the course of several hours, drowsiness worsens and a soporous state develops. During this period, convulsions and meningeal symptoms are sometimes observed ( photophobia and muscle stiffness), consciousness becomes confused. If there is no treatment, a deep coma develops, during which blood pressure drops, reflexes disappear, and breathing becomes arrhythmic. During a coma, there is no reaction to external stimuli, vascular tone changes and temperature regulation is disrupted. This condition is critical and requires resuscitation measures. Toxic shock Also, with toxic shock, damage to the nervous system occurs, which is manifested by confusion, psychomotor agitation, and fever ( due to a violation of temperature regulation). Acute renal failure Symptoms of acute renal failure are rapid deterioration of the condition, decreased diuresis, and dark colored urine. In the blood there is a disturbance in the water-electrolyte balance, a shift in the alkaline balance, and an increase in the number of leukocytes. Acute massive hemolysis Hemorrhagic syndrome These blood clots are formed due to enhanced thrombocytopoiesis, which, in turn, is activated due to the destruction of red blood cells. Thus, a vicious circle is formed. As a result of hemolysis of red blood cells, numerous breakdown products are formed, which enhance the formation of blood clots. The more intense the hemolysis, the stronger the hemorrhagic and DIC syndrome. Is there a vaccine against malaria? A vaccine against malaria exists, but it is not currently universal. Its routine use is not approved in European countries. The first malaria vaccine was created in 2014 in the UK by the pharmaceutical company GlaxoSmithKline. British scientists have created the drug mosquirix ( moskirix), which is intended to vaccinate populations most at risk of contracting malaria. Since 2015, this vaccine has been used to vaccinate children in many countries in Africa, where malaria is most common. Moskirix vaccination is given to children from one and a half months to two years. It is at this age that African children are most susceptible to malaria. According to scientists, as a result of vaccination, not all children developed immunity against malaria. In children aged 5 to 17 months, the disease was prevented in 56 percent of cases, but in children under 3 months it was prevented in only 31 percent of cases. Thus, the currently created malaria vaccine has a number of negative qualities, which suspends its large-scale use. New developments are currently underway to create a more universal malaria vaccine. According to scientists, the first mass vaccinations should appear by 2017. |
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Malaria
Malaria causes about 350-500 million infections and about 1.3-3 million deaths in humans each year. Sub-Saharan Africa accounts for 85-90% of these cases, with the vast majority affecting children under 5 years of age. Death rates are expected to double over the next 20 years.
The first chronicled evidence of fever caused by malaria was discovered in China. They date back to approximately 2700 BC. e., during the reign of the Xia dynasty.
What provokes / Causes of Malaria:
Malaria is caused by protozoa of the genus Plasmodium. Four species of this genus are pathogenic for humans: P.vivax, P.ovale, P.malariae and P.falciparum. In recent years, it has been established that a fifth species, Plasmodium knowlesi, also causes malaria in humans in Southeast Asia. A person becomes infected with them at the time of inoculation (injection) by a female malaria mosquito of one of the stages of the life cycle of the pathogen (the so-called sporozoites) into the blood or lymphatic system, which occurs during blood sucking.
After a short stay in the blood, the sporozoites of Plasmodium falciparum penetrate the liver hepatocytes, thereby giving rise to the preclinical hepatic (exoerythrocytic) stage of the disease. Through a process of asexual reproduction called schizogony, one sporozoite eventually produces 2,000 to 40,000 hepatic merozoites, or schizonts. In most cases, these daughter merozoites return to the bloodstream within 1-6 weeks. In infections caused by some North African strains of P.vivax, the primary release of merozoites into the blood from the liver occurs approximately 10 months after infection, coinciding with a short period of mass mosquito breeding in the following year.
The erythrocyte, or clinical, stage of malaria begins with the attachment of merozoites that have entered the blood to specific receptors on the surface of the erythrocyte membrane. These receptors, which serve as targets for infection, appear to be different for different types of malarial Plasmodium.
Epidemiology of malaria
Under natural conditions, malaria is a naturally endemic, protozoal, anthroponotic, vector-borne infection.
Malaria pathogens find hosts in various representatives of the animal world (monkeys, rodents, etc.), but as a zoonotic infection, malaria is extremely rare.
There are three routes of malaria infection: transmissible, parenteral (syringe, post-hemotransfusion) and vertical (transplacental).
The main transmission route is transmission. Human malaria is transmitted by female mosquitoes of the genus Anopheles. Males feed on flower nectar.
The main vectors of malaria in Ukraine:
An. messae, An. maculipennis, An. atroparvus, An. sacharovi, An. superpictus, An. pulcherrimus etc.
The life cycle of mosquitoes consists of a number of stages: egg - larva (I - IV instar) - pupa - imago. Fertilized females attack humans in the evening or at night and feed on blood. In females that are not engorged with blood, eggs do not develop. Females engorged with blood remain in the dark corners of residential or utility rooms, thickets of vegetation until the end of digestion of the blood and maturation of the eggs. The higher the air temperature, the faster the development of eggs in the female’s body is completed (gonotrophic cycle): at a temperature of +30°C - up to 2 days, at + 15°C - up to 7 in P. vivax. Then they rush to a pond where they lay eggs. Such reservoirs are called anophelogenic.
The maturation of the aquatic stages of vector development also depends on temperature and lasts 2-4 weeks. At temperatures below +10°C, mosquitoes do not develop. During the warm season of the year, up to 3 - 4 generations of mosquitoes can appear in the middle latitudes, 6 - 8 in the south, and up to 10 - 12 in the tropics.
For sporogony, a temperature of at least +16°C is required. Sporogony of P. vivax at +16°C is completed in 45 days, at +30°C - in 6.5 days. The minimum temperature for sporogony of P. falciparum is +19 - 20°C, at which it is completed in 26 days, at +30°C - in 8 days.
The malaria transmission season depends on this. In the tropics, the malaria transmission season reaches 8-10 months, in the countries of equatorial Africa it is year-round.
In temperate and subtropical climates, the malaria transmission season is limited to the summer-autumn months and lasts from 2 to 7 months.
Sporozoites in mosquitoes overwintering die, so females that emerge in the spring are not carriers of malarial plasmodia, and in each new season, mosquitoes are infected with malaria patients.
Intrauterine infection of the fetus through the placenta is possible if the pregnant mother has an infection, but more often this occurs during childbirth.
With these forms of infection, schizont malaria develops, in which the phase of tissue schizogony is absent.
Susceptibility to malaria is universal. Only representatives of the Negroid race are immune to P. vivax.
The spread of malaria is determined by geographical, climatic and social factors. The distribution boundaries are 60 - 64° north latitude and 30° south latitude. However, the species range of malaria is uneven. The widest range is that of P. vivax, the causative agent of three-day malaria, the distribution of which is determined by geographic boundaries.
The range of tropical malaria is smaller because P. falciparum requires higher temperatures to develop. It is limited to 45° - 50° N. w. and 20° S. w. Africa is the world's hotbed of tropical malaria.
The second place in distribution in Africa is occupied by four-day malaria, the range of which reaches 53° N. w. and 29° S. w. and which has a focal, nested character.
P. ovale is found mainly in the countries of Western and Central Africa and on some islands of Oceania (New Guinea, Philippines, Thailand, etc.).
In Ukraine, malaria has been practically eliminated and mainly imported malaria and isolated cases of local infection secondary to imported ones are registered.
Malaria is brought into the territory of Ukraine from tropical countries and from neighboring countries - Azerbaijan and Tajikistan, where there are residual foci.
The largest portion of imported cases is three-day malaria, which is the most dangerous due to possible transmission by mosquitoes sensitive to this type of pathogen. In second place is the importation of tropical malaria, the most severe clinically, but less dangerous epidemiologically, since Ukrainian mosquitoes are not sensitive to P. falciparum imported from Africa.
Cases of importation with an unknown cause of infection are registered - “airport”, “baggage”, “accidental”, “transfusion” malaria.
The WHO European Bureau, due to political and economic instability in the world, increased migration and the implementation of large-scale irrigation projects, identifies malaria as a priority problem due to the possibility of a return of the infection.
Under the influence of these factors, the formation of new foci of malaria is possible, that is, settlements with adjacent anophelogenic reservoirs.
In accordance with the WHO classification, there are 5 types of malaria foci:
pseudofocus - the presence of imported cases, but there are no conditions for transmission of malaria;
potential - the presence of imported cases and there are conditions for the transmission of malaria;
active new - the emergence of cases of local infection, malaria transmission has occurred;
active persistent - the presence of cases of local infection for three years or more without interruption of transmission;
inactive - transmission of malaria has ceased; there have been no cases of local infection over the past two years.
An indicator of the intensity of the risk of malaria infection according to the WHO classification is the splenic index in children from 2 to 9 years old. According to this classification, there are 4 degrees of endemicity:
1. Hypoendemia - splenic index in children from 2 to 9 years old up to 10%.
2. Mesoendemia - the splenic index in children from 2 to 9 years old is 11 - 50%.
3. Hyperendemia - the splenic index in children from 2 to 9 years is above 50% and high in adults.
4. Holoendemia - the splenic index in children from 2 to 9 years of age is constantly above 50%, the splenic index in adults is low (African type) or high (New Guinea type).
Pathogenesis (what happens?) during Malaria:
Based on the method of infection, sporozoite and schizont malaria are distinguished. Sporozoite infection- This is a natural infection through a mosquito, with the saliva of which sporozoites penetrate the human body. In this case, the pathogen goes through the tissue (in hepatocytes) and then the erythrocyte phases of schizogony.
Schizont malaria is caused by the introduction of ready-made schizonts into the human blood (hemotherapy, syringe malaria), therefore, unlike sporozoite infection, there is no tissue phase, which determines the features of the clinic and treatment of this form of the disease.
The direct cause of attacks of malarial fever is the entry into the blood during the disintegration of morulae of merozoites, which are foreign proteins, malarial pigment, hemoglobin, potassium salts, and remnants of red blood cells, which change the specific reactivity of the body and, acting on the heat-regulating center, cause a temperature reaction. The development of an attack of fever in each case depends not only on the dose of the pathogen (“pyrogenic threshold”), but also on the reactivity of the human body. The alternation of attacks of fever characteristic of malaria is due to the duration and cyclicity of erythrocyte schizogony of the leading generation of plasmodia of one or another species.
Foreign substances circulating in the blood irritate the reticular cells of the spleen and liver, causing their hyperplasia, and, over a long period of time, the proliferation of connective tissue. Increased blood supply to these organs leads to their enlargement and pain.
Sensitization of the body by a foreign protein and the development of autoimmunopathological reactions are important in the pathogenesis of malaria. The breakdown of red blood cells during erythrocyte schizogony, hemolysis as a result of the formation of autoantibodies, and increased phagocytosis of red blood cells of the reticuloendothelial system of the spleen are the causes of anemia.
Relapses are typical for malaria. The reason for short-term relapses in the first 3 months after the end of the primary acute symptoms is the persistence of some erythrocyte schizonts, which, due to a decline in immunity, begin to actively multiply again. Late or distant relapses, characteristic of tertian and oval malaria (after 6-14 months), are associated with the completion of bradysporozoite development.
Symptoms of Malaria:
All clinical manifestations of malaria are associated only with erythrocyte schizogony.
There are 4 types of malaria: three-day, oval malaria, four-day and tropical.
Each species form has its own characteristics. However, attacks of fever, splenohepatomegaly and anemia are typical.
Malaria is a polycyclic infection, during its course there are 4 periods: the incubation period (primary latent), the primary acute manifestations, the secondary latent period and the relapse period. The duration of the incubation period depends on the type and strain of the pathogen. At the end of the incubation period, symptoms appear - harbingers, prodromes: fatigue, muscle pain, headache, chills, etc. The second period is characterized by repeated attacks of fever, for which a typical staged development is a change in the stages of chills, heat and sweat. During a chill that lasts from 30 minutes. up to 2 - 3 hours, the body temperature rises, the patient cannot warm up, the limbs are cyanotic and cold, the pulse is rapid, breathing is shallow, blood pressure is increased. By the end of this period, the patient warms up, the temperature reaches 39 - 41 ° C, a period of heat begins: the face turns red, the skin becomes hot and dry, the patient is excited, restless, headaches, delirium, confusion, and sometimes convulsions are noted. At the end of this period, the temperature drops rapidly, which is accompanied by profuse sweating. The patient calms down, falls asleep, and a period of apyrexia begins. However, then the attacks are repeated with a certain cyclicity, depending on the type of pathogen. In some cases, the initial (initial) fever is irregular or constant.
Against the background of attacks, the spleen and liver enlarge, anemia develops, all body systems suffer: cardiovascular (myocardial dystrophic disorders), nervous (neuralgia, neuritis, sweating, chilliness, migraines), genitourinary (symptoms of nephritis), hematopoietic (hypochromic anemia, leukopenia, neutropenia, lymphomonocytosis, thrombocytopenia), etc. After 10 - 12 or more attacks, the infection gradually subsides, and a secondary latent period begins. If treatment is incorrect or ineffective, immediate (3 months), late or distant (6-9 months) relapses occur after several weeks or months.
Three-day malaria. Duration of the incubation period: minimum - 10 - 20 days, for infection with bradysporozoites - 6 - 12 or more months.
Prodromal phenomena at the end of incubation are characteristic. A few days before the onset of attacks, chills, headache, lower back pain, fatigue, and nausea appear. The disease begins acutely. For the first 5-7 days, the fever may be of an irregular nature (initial), then an intermittent type of fever develops with a typical alternation of attacks every other day. An attack is characterized by a clear change in the stages of chills, heat and sweat. The period of heat lasts 2 - 6 hours, less often 12 hours and is replaced by a period of sweating. Attacks usually occur in the first half of the day. The spleen and liver enlarge after 2-3 temperature paroxysms and are sensitive to palpation. At 2-3 weeks, moderate anemia develops. This species form is characterized by near and distant relapses. The total duration of the disease is 2-3 years.
Malaria oval. In many clinical and pathogenetic characteristics it is similar to tertian malaria, but differs in a milder course. The minimum incubation period is 11 days; long-term incubation can occur, as with a three-day incubation - 6 - 12 - 18 months; The deadline for incubation is known from publications - 52 months.
Fever attacks occur every other day and, unlike 3-day malaria, occur mainly in the evening. Early and distant relapses are possible. The duration of the disease is 3-4 years (in some cases up to 8 years).
Tropical malaria. The minimum duration of the incubation period is 7 days, fluctuations up to 10 - 16 days. Prodromal phenomena at the end of the incubation period are characteristic: malaise, fatigue, headache, joint pain, nausea, loss of appetite, feeling of chills. The initial fever is of a constant or irregular nature, initial fever. Patients with tropical malaria often do not have the typical symptoms of an attack: no or mild chills, the febrile period lasts up to 30 - 40 hours, the temperature drops without sudden sweating, muscle and joint pain are pronounced. Cerebral phenomena are noted - headache, confusion, insomnia, convulsions, hepatitis with cholemia often develops, signs of respiratory pathology arise (bronchitis, bronchopneumonia); quite often abdominal syndrome is expressed (abdominal pain, nausea, vomiting, diarrhea); Kidney function is impaired.
Such a variety of organ symptoms makes diagnosis difficult and causes erroneous diagnoses.
The duration of tropical malaria is from 6 months. up to 1 year.
Malarial coma- cerebral pathology in tropical malaria is characterized by rapid, rapid, sometimes lightning-fast development and a severe prognosis. During its course, three periods are distinguished: somnolence, stupor and deep coma, the mortality rate of which is close to 100%.
Often, cerebral pathology is aggravated by acute renal failure.
Hemoglobinuric fever, pathogenetically associated with intravascular hemolysis, is characterized by an equally severe course. Most often, it develops in individuals with genetically determined enzymopenia (deficiency of the G-6-PD enzyme) while taking antimalarial drugs. It may result in the death of the patient from anuria due to the development of acute renal failure.
The algid form of tropical malaria is less common and is characterized by a cholera-like course.
Mixed malaria.
In areas endemic for malaria, simultaneous infection with several species of Plasmodium occurs. This leads to an atypical course of the disease and makes diagnosis difficult.
Malaria in children.
In malaria-endemic countries, malaria is one of the causes of high mortality among children.
Children under 6 months of age born to immune women in these areas acquire passive immunity and very rarely become ill with malaria. The most severe illness, often with fatal outcome, occurs in children aged 6 months and older. up to 4 - 5 years. Clinical manifestations in children of this age are unique. Often the most striking symptom, malarial paroxysm, is absent. At the same time, symptoms such as convulsions, vomiting, diarrhea, abdominal pain are observed, there are no chills at the beginning of the paroxysm and no sweating at the end.
On the skin there are rashes in the form of hemorrhages and spotted elements. Anemia increases rapidly.
In children of older age groups, malaria usually progresses in the same way as in adults.
Malaria in pregnant women.
Malarial infection has a very adverse effect on the course and outcome of pregnancy. It can cause abortion, premature birth, eclampsia in pregnancy and death.
Vaccinal (schizont) malaria.
This malaria can be caused by any human malaria species, but the predominant species is P. malariae.
In past years, the method of pyrotherapy was used to treat patients with schizophrenia and neurosyphilis, infecting them with malaria by injecting the blood of a malaria patient. This is the so-called therapeutic malaria.
Currently, depending on the conditions of infection with Plasmodium-infected blood, blood transfusion and syringe malaria are isolated. The literature describes cases of accidental malaria - occupational infection of medical and laboratory personnel, as well as cases of infection of organ transplant recipients.
The viability of plasmodium in the blood of donors at 4°C reaches 7-10 days.
It should be noted that post-transfusion malaria can also be severe and, in the absence of timely treatment, have an unfavorable outcome. Diagnosing it is difficult primarily due to the doctor’s lack of assumption about the possibility of hospital-acquired malaria infection.
The increase in cases of schizont malaria is currently associated with the spread of drug addiction.
When treating such patients, there is no need to prescribe tissue schizontocides. One of the forms of schizont malaria is a congenital infection, i.e. infection of the fetus during intrauterine development (transplacentally if the placenta is damaged) or during childbirth.
Immunity in malaria.
In the process of evolution, humans have developed different mechanisms of resistance to malaria:
1. innate immunity associated with genetic factors;
2. acquired active;
3. acquired passive immunity.
Acquired active immunity caused by past infection. It is associated with humoral restructuring, the production of antibodies, and an increase in the level of serum immunoglobulins. Only a small portion of antibodies play a protective role; in addition, antibodies are produced only against the erythrocyte stages (WHO, 1977). Immunity is unstable, quickly disappears after the body is freed from the pathogen, and is species- and strain-specific. One of the essential factors of immunity is phagocytosis.
Attempts to create artificial acquired active immunity through the use of vaccines continue to be important. The possibility of creating immunity as a result of vaccination with attenuated sporozoites has been proven. Thus, immunization of people with irradiated sporozoites protected them from infection for 3-6 months. (D. Clyde, V. McCarthy, R. Miller, W. Woodward, 1975).
Attempts have been made to create merozoite and gametic antimalarial vaccines, as well as a synthetic multispecies vaccine proposed by Colombian immunologists (1987).
Complications of malaria: malarial coma, splenic rupture, hemoglobinuric fever.
Diagnosis of Malaria:
Diagnosis of malaria is based on an analysis of the clinical manifestations of the disease, epidemiological and geographical history data and is confirmed by the results of laboratory blood tests.
The final diagnosis of the specific form of malaria infection is based on the results of laboratory blood tests.
With the research regimen recommended by WHO for mass examinations, it is necessary to carefully examine 100 fields of view in a thick drop. Study two thick drops for 2.5 minutes. per each more effective than examining one thick drop for 5 minutes. When malaria plasmodia are detected in the very first fields of view, viewing of slides is not stopped until 100 fields of view have been viewed, so as not to miss a possible mixed infection.
If indirect signs of a malarial infection are detected in a patient (stay in a malarial zone, hypochromic anemia, the presence of pigmentophages in the blood - monocytes with clumps of malarial pigment almost black in the cytoplasm), it is necessary to examine the thick drop more carefully and not two, but a series - 4 - 6 at one injection. In addition, if the result is negative in suspicious cases, it is recommended to draw blood repeatedly (4-6 times a day) for 2-3 days.
The laboratory response indicates the Latin name of the pathogen, the generic name Plasmodium is abbreviated to “P”, the species name is not abbreviated, as well as the stage of development of the pathogen (required when P. falciparum is detected).
To monitor the effectiveness of treatment and identify possible resistance of the pathogen to the antimalarial drugs used, the number of plasmodiums is counted.
The detection of mature trophozoites and schizonts - morulae - in the peripheral blood in tropical malaria indicates a malignant course of the disease, which the laboratory must urgently report to the attending physician.
The former have found greater use in practice. More often than other test systems, indirect immunofluorescence reaction (IDIF) is used. Smears and drops of blood with a large number of schizonts are used as an antigen for diagnosing three-day and four-day malaria.
To diagnose tropical malaria, the antigen is prepared from an in vitro culture of P. falciparum, since most patients do not have schizonts in their peripheral blood. Therefore, for the diagnosis of tropical malaria, the French company BioMerieux produces a special commercial kit.
Difficulties in obtaining the antigen (from a patient's blood or from an in vitro culture), as well as insufficient sensitivity, make it difficult to introduce NRIF into practice.
New methods for diagnosing malaria have been developed based on luminescent immunoenzyme sera, as well as using monoclonal antibodies.
The enzyme-linked immunosorbent test system using soluble malaria plasmodium antigens (REMA or ELISA), like RNIF, is used mainly for epidemiological studies.
Treatment of Malaria:
The most common drug used to treat malaria today, as before, is quinine. It was replaced by chloroquine for a time, but quinine has recently gained popularity again. The reason for this was the appearance in Asia and then spread throughout Africa and other parts of the world, Plasmodium falciparum with a mutation of resistance to chloroquine.
Extracts of the plant Artemisia annua (Artemisia annua), which contain the substance artemisinin and its synthetic analogues, are highly effective, but their production is expensive. Currently (2006) the clinical effects and the possibility of producing new drugs based on artemisinin are being studied. Other work by a team of French and South African researchers developed a group of new drugs known as G25 and TE3, which were successfully tested in primates.
Although anti-malarial drugs are available on the market, the disease poses a threat to people who live in endemic areas where there is no adequate access to effective drugs. According to Doctors Without Borders, the average cost of treating a person infected with malaria in some African countries is only US$0.25 to US$2.40.
Prevention of Malaria:
Methods that are used to prevent the spread of the disease or for protection in areas where malaria is endemic include preventative medications, mosquito control, and mosquito bite preventatives. There is currently no vaccine against malaria, but active research is underway to create one.
Preventive medicines
A number of drugs used to treat malaria can also be used for prevention. Typically, these medications are taken daily or weekly at a lower dose than for treatment. Preventive medications are typically used by people visiting areas at risk of contracting malaria and are not used much by the local population due to the high cost and side effects of these medications.
Since the beginning of the 17th century, quinine has been used for prevention. The 20th century synthesis of more effective alternatives such as quinacrine (acriquine), chloroquine and primaquine has reduced the use of quinine. With the emergence of a strain of Plasmodium falciparum resistant to chloroquine, quinine has returned as a treatment but not a preventative.
Destruction of mosquitoes
Efforts to control malaria by killing mosquitoes have achieved success in some areas. Malaria was once common in the United States and Southern Europe, but the draining of swamps and improved sanitation, along with the control and treatment of infected people, have removed these areas from being unsafe. For example, in 2002, there were 1,059 cases of malaria in the United States, including 8 deaths. On the other hand, malaria has not been eradicated in many parts of the world, especially in developing countries - the problem is most widespread in Africa.
DDT has proven itself to be an effective chemical against mosquitoes. It was developed during World War II as the first modern insecticide. It was first used to fight malaria and then spread to agriculture. Over time, pest control, rather than mosquito eradication, has come to dominate the use of DDT, especially in developing countries. Throughout the 1960s, evidence of the negative effects of its misuse increased, eventually leading to the ban of DDT in many countries in the 1970s. Prior to this time, its widespread use had already led to the emergence of DDT-resistant mosquito populations in many areas. But now there is the prospect of a possible return of DDT. The World Health Organization (WHO) now recommends the use of DDT against malaria in endemic areas. In addition, the use of alternative insecticides in areas where mosquitoes are resistant to DDT is proposed to control the evolution of resistance.
Mosquito nets and repellents
Mosquito nets help keep mosquitoes away from people and thereby significantly reduce the number of infections and transmission of malaria. Nets are not a perfect barrier, so they are often used in conjunction with an insecticide that is sprayed to kill mosquitoes before they find their way through the net. Therefore, insecticide-impregnated nets are much more effective.
Covered clothing and repellents are also effective for personal protection. Repellents fall into two categories: natural and synthetic. Common natural repellents are essential oils of certain plants.
Examples of synthetic repellents:
DEET (active ingredient - diethyltoluamide) (eng. DEET, N,N-diethyl-m-toluamine)
IR3535®
Bayrepel®
Permethrin
Transgenic mosquitoes
Several options for possible genetic modifications of the mosquito genome are being considered. One potential method for controlling mosquito populations is the method of rearing sterile mosquitoes. Significant progress has now been made towards developing a transgenic or genetically modified mosquito that is resistant to malaria. In 2002, two groups of researchers already announced the development of the first samples of such mosquitoes.
Which doctors should you contact if you have Malaria:
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How to contact the clinic:
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If you have previously performed any research, Be sure to take their results to a doctor for consultation. If the studies have not been performed, we will do everything necessary in our clinic or with our colleagues in other clinics.
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Almost 100 countries with tropical and subtropical climates consider malaria to be the most serious health problem. The disease poses a danger both to residents of endemic risk zones and to tourists who come on vacation to hot countries.
What kind of disease is this
The most frequently reported cases of infection are in Africa, Southeast Asia, and the Eastern Mediterranean. Any of these regions is dangerous for people with immunodeficiency, the elderly, pregnant women, and young children. All of them suffer from severe illness and, due to malaria, face an increased risk of death, miscarriage, and stillbirth.
The causative agent of the disease is a simple unicellular organism of the genus Plasmodium. It comes in 4 types. In this regard, experts distinguish 4 forms of the disease:
- Ovale malaria. This is a relatively rare disease. It is found in West Africa. Oval malaria accounts for about 1% of cases. The causative agent is Plasmodium ovale.
- Four-day form. It is considered rare (up to 7% of cases). It is caused by Plasmodium malariae.
- Three-day form. It is caused by Plasmodium vivax. The disease caused by this pathogen is widespread in the world (up to 43% of cases).
- Tropical malaria. This form is the most common (up to 50% of cases). Its causative agent is Plasmodium falciparum.
How is malaria transmitted?
The disease can occur in almost any person living or who has visited endemic risk areas. There are just a few features:
- indigenous people of West Africa exhibit congenital immunity to Plasmodium vivax;
- People with sickle cell anemia easily tolerate the tropical form of the disease, which is considered the most dangerous, rapidly progressing if left untreated.
Malaria is caused by female Anopheles mosquitoes. They act as carriers of plasmodia. Insects transmit pathogens from sick people to healthy people through bites. In the past, several isolated cases of human infection with zoonotic species of Plasmodium (Plasmodium knowlesi and Plasmodium cynomolgi) have been reported. These pathogens were transmitted to humans by mosquitoes after being bitten by sick monkeys.
With malaria, the incubation period depends on the type of plasmodium that has entered the body. The most rapid development of the disease is observed in the tropical form. The first symptoms appear after 8-16 days. The incubation period for the four-day form ranges from 3 to 6 weeks. Pathogens such as Plasmodium vivax and Plasmodium ovale are characterized by the preservation of dormant hypnozoites in the liver. The period from infection to activation can range from 6-8 months to 3 years.
First signs and main symptoms
Fever, chills, headache, muscle pain, muscle weakness, cough, vomiting, abdominal pain, diarrhea are possible clinical signs. In the absence of treatment, a negative progression of malaria is observed, the disease leads to manifestations of failure of individual organs (acute renal failure, pulmonary edema). Coma and death may occur.
Of all the symptoms, fever deserves special attention. If it occurs for unknown reasons 7 days or more after the first possible contact with the pathogen, you should immediately consult a doctor. It is advisable to visit a specialist no later than 24 hours after the onset of symptoms indicating malaria, because treatment started in a timely manner will reduce or eliminate the likelihood of death.
An important feature of the disease is its paroxysmal course. In the first days, the fever is of the wrong type (temperature fluctuations are observed throughout the day without patterns). It lasts 1-3 days for three-day and oval malaria and 5-6 days for tropical malaria. After this period, the clinical picture takes on the appearance of typical paroxysms (attacks). They clearly have 3 phases - chills, fever, sweating. The duration of attacks varies from 1-2 hours to 12 hours.
Paroxysms are repeated either after 48 hours (with tropical, three-day and oval malaria), or after 72 hours (with the four-day form of the disease). Between attacks, the condition of sick people is satisfactory. After 2-3 temperature paroxysms, the liver and spleen increase in size. Anemia develops from the second week of the disease.
Diagnosis and treatment
Medicine for malaria is prescribed after confirmation of the presence of the disease. Diagnosis includes anamnesis and clinical examination. Laboratory methods are a mandatory part of it. One of them is microscopic. During its use, blood products prepared by the “thin smear” and “thick drop” method and stained according to Romanovsky-Giemsa are examined. The microscopic method allows you to confirm or exclude the disease, determine the type of pathogen, and the severity of the infectious process.
After confirming the diagnosis, the doctor thinks about how to rid the patient of malaria. Treatment begins in a hospital setting. It includes:
- use of etiotropic drugs (Daraprim, Delagil, etc.);
- conducting pathogenetic therapy (prescribed drugs - Prednisolone, Korglykon, ascorbic acid, multivitamins).
Prognosis and prevention
The prognosis is favorable with timely diagnosis and treatment of uncomplicated malaria. Full recovery occurs quickly. The most dangerous are malignant forms of the disease. The mortality rate caused by them is 1%. For example, in the cerebral (comatose) form, multiple hemorrhages are observed in the brain tissue and meninges. The disease is manifested by intense headache, nausea, repeated or repeated vomiting, disturbances and loss of consciousness. Death occurs due to increasing cardiac and respiratory failure.
It is possible to avoid the disease and its negative consequences, because malaria prevention has been developed. One of the effective measures is the use of drugs prescribed for treatment. It is recommended that you first consult with your doctor regarding such prophylaxis. Medicines are prescribed to those people who are going to travel to endemic areas. When drawing up a prevention plan, the specialist takes into account:
- malariological situation in the region, malaria season, period of disease transmission (part of the year during which pathogens can be transferred from mosquitoes to humans);
- planned duration of stay in the endemic territory;
- the presence of individual intolerance to drugs.
In order to reduce the likelihood of developing malaria, prevention also includes the use of personal protective equipment (mosquito nets, repellents). An important role is played by chemical, physical, biological and hydraulic measures carried out by countries at the state level (bringing water sources to proper sanitary and technical condition, leveling the banks, clearing vegetation, etc.). A vaccine is also being developed that could protect 100% from infection.
